1 Risø National Laboratory for Sustainable Energy, Technical University of Denmark
Patient safety - the prevention of medical error and adverse events - and the initiative of developing safety cultures to assure patients from harm have become one of the central concerns in quality improvement in healthcare both nationally andinternationally. This subject raises numerous challenging issues of systemic, organisational, cultural and ethical relevance, which this dissertation seeks to address through the application of different disciplinary approaches. The main focus of researchis safety culture; through empirical and theoretical studies to comprehend the phenomenon, address the problems, and suggest possible solutions for improving patient safety through the promotion of safety culture and ethics. I seek to illuminate theissues of patient safety from several perspectives; the organizational healthcare system, in particular the healthcare workers perspectives and experiences, and those of patients who experience the physical effect of poor patient safety. The dissertationconsists of nine papers and an appendix. Paper 1 describes the results of doctors and nurses attitudes towards reporting and the handling of adverse events. Paper 2 is a study and “review” of the international literature of assessment of safety culture inhealthcare. Paper 3 summarizes results of an intervention study introducing a reporting system and using a questionnaire survey of safety culture within three Danish hospitals to measure the effects. Paper 4 reports key results from the study in paper 3,demonstrating significant, consistent and sometimes large differences in terms of safety culture factors across the units participating in the survey. Paper 5 is the results of a study of the relation between safety culture, occupational health andpatient safety using a safety culture questionnaire survey and interviews with staff and management in four hospital departments. The appendix contains the Patient Safety Culture Questionnaire tool that I have developed, tested and revised for use in theDanish hospital setting based on the research projects on safety culture described in papers 3, 4 and 5. Paper 6 concerns the attitudes and responses to adverse events from the patient’s point of view, using a questionnaire survey, and comparing these tostaffs responses to the same questions.
Diagnostik og behandling; Risø-PhD-25(EN); Risø-PhD-25; Risø-PhD-0025